The heat versus ice debate is something I talk about with my patients on a regular basis. Television has done a good of teaching us we should be using heat or ice for our everyday body aches. The fifty dollar question remains, which should I use for my condition. Both forms of home therapy are relatively benign and aren't likely to cause significant adverse reaction. That being said, heating a condition that should be iced can make it more painful in the short term. The following are my guidelines that I use and my rational for their use.
Let's start with heat. Application of a heating pad, or hot moist pack, is aimed at increasing blood flow to the affected area. The idea is that increasing blood flow to the area will decrease muscular spasms. Increase temperature of the area will allow increased muscle elasticity. This again will decrease muscular tightness and help reduce pain originating from said muscles. Common descriptions that indicate muscular pain are achy pain, dull pain, stiffness, tightness and/or soreness.
Now to common conditions which respond better to ice. Ice is commonly used to aid in relieving swelling or inflammation. Commonly ice is used 24 to 48 hours after initial injury as this is likely when the most swelling will occur. Other types of pain that indicate swelling or inflammation of soft tissues are numbness, tingling, or burning sensations, which are commonly associated with nerve irritation or spinal disc injury.
Duration of hot pack use shoulder never exceed 20-25 minutes, depending on how hot the pack is. In regards to ice, 10 minutes should be sufficient, less if the compress is applied directly to the skin.
As always, if you have additional questions contact your health care provider for more detailed response to which form of home therapy is appropriate for you.

Bryan M. Steele, DC
O'Leary Chiropractic, PLLC

Let's talk about injury prevention. From previous posts you know that stretching before exercise or activity does not decrease your likelihood of injury. That is, stretching your hamstrings does not prevent a hamstring pull during a sprint. With that being said, what can you do to prevent injury? Very simply put, you can warm up before you dive into action.
Jogging before a 100 meter sprint seems obvious, but what would one do before working in the garden? Its unlikely many would be willing to run around the block, but organizing your work so that you can start with the less physically intense activities first will likely raise your body temperature sufficiently. Less intense activity will provide a sufficient "warm up" so you will be better able to handle more difficult tasks such as pushing a wheel barrow or carrying sod.
Still not convinced? Here are a few of the more important reasons to warm up before physical activity. Increased body temperature increases elasticity of the muscles and tendons which will make muscle pulls or strains less likely and increase range of motion. Also, increasing temperature of skeletal muscles makes energy producing processes more active and thus makes your muscles more efficient, quicker to contract and relax. Faster muscle reaction is particularly important for proper stabilization of your lower back during lifting.
Keep these factors in mind this weekend and have healthy back!

Bryan M. Steele, DC
O'Leary Chiropractic, PLLC

Degenerative disc disease, or DDD as I'll refer to it for ease of reading, is a broad and general diagnosis that is often given to people with lower back or neck pain. Some would say it's a five dollar word for a one dollar condition. What DDD actually refers to is the wear and tear that happens to the discs in the spine. From previous blog posts we now know that the discs in the spine provide shock absorption and properly space the vertebra, the bones of the spine.

As the name implies it is a slow process that occurs over time. I hesitate to call it "normal" but certainly many people will encounter disc degeneration to some extent in their lifetime. As we age the discs in the spine start to lose water and become dehydrated. This causes them to become slightly thinner. As the disc loses water it becomes more susceptible to further degeneration such as tears in the outside of the disc, the annulus. A good way to think of it is cooking a hamburger on the grill. If you put pressure on the burger hard enough and long enough the juice will come out, the hamburger will get dry and eventually crack around the edges. Now, certainly this is not exactly what happens but it does serve as a decent analogy.

Many people with mild to moderate DDD have no or very little pain associated with it. Most are able to live life as they see fit and continue their healthy and active lifestyle without long term implications.

Spring is here, although you may not know if you looked out the window on Monday. If you're like me then you're probably itching to get outside and enjoy the nice weather. This brings us to your spine. As always prevention is the key when talking about lower back and neck pain. So let's look at research, what does research say is best for prevention of lower back pain? The answer is a generally active lifestyle.
What is a generally active lifestyle? Simple put, it is a lifestyle that involves physical activity as opposed to sedentary activity. An example would be going for a hike on a nice day rather than watching a movie. Going to the park to throw the Frisbee rather than browsing your favorite social media site. Before we go further I would like to reiterate some of my previous posts where I have touted specific exercise. Specific strengthening exercise for the core or neck and upper back musculature is very effective in relieving and prevention injury. A generally active lifestyle outperforms these exercises over the course of a lifetime because at some point most people will stop going to the gym or forget about these exercises. If going for a walk is something you enjoy, you will never forget about that and you can reap the benefits for an entire life.
So, as the weather continues to warm remember this. Go have fun, enjoy the weather, be active, and do your stabilization exercise, as this combination will afford you the best chance at a healthy spine throughout life.

Bryan M. Steele, DC
O'Leary Chiropractic, PLLC

 Whiplash is a painful and debilitating injury often the result of a rear end motor vehicle accident. Essentially the cause of whiplash, or cervical acceleration-deceleration (CAD), is a quick snapping of the head backwards on rear impact coupled with rapid forward head movement. Whiplash syndrome is classically associated with motor vehicle accidents but can certainly be caused by other traumatic events such as a fall.
 Common symptoms include cervical pain, headaches associated with increased neck pain, upper back pain and possible pain down one or both of the arms. Weakness, numbness, burning sensation or incoordination of the arms and hands is not usually present, but may be indicative of a more serious injury. Immediate pain upon impact is common although many people note only minor symptoms until 24-48 hours after the accident.
 An interesting fact, being struck in the rear end by a car driving 5 mph can exert a G-force of 9 on the cervical spine. Compare that to a top fuel dragster which accelerates at a G-force of roughly 5.4. Increase the speed of the car and the amount of sheer force on the spine increase exponentially. The result can be significant soft tissue and joint damage.
 X-rays, MRI and CT scans are often used to rule out more serious conditions especially when significant damage has been done to one or both automobiles. Normal imaging studies usually result in treatment which includes medication for pain management and therapy. Therapy options should be focused on restoring normal range of motion and reducing muscular and joint pain in the acute phase. Once pain levels have been reduced strengthening exercise should be used to finish rehabilitation.

Bryan M. Steele, DC
O'Leary Chiropractic, PLLC 

 I often have patients ask me about supplements. Among the most popular are Glucosamine Chondroitin, a compound thought to improve joint health, and vitamin mixes for bone health. While the research on their usefulness is decidedly undecided, there are a few things that you should keep in mind should you feel the need to experiment.
 Not all brands are created equal. As with most things, higher quality usually cost more. Follow these general guidelines and you have a better chance of getting a quality product. First, read the label of your supplement. Look at the section labeled "other ingredients". These are essentially fillers and usually do nothing more than take up space. The higher quality brands usually have very few of other ingredients. Second, when buying a vitamin you should realize that certain combinations of vitamins will improve or diminish absorption. I couldn't possible list all the combinations but realize a vitamin is no good if it cannot be broken down and absorbed. Fairly comprehensive lists can be found through search engines or in most vitamin/supplement stores. Finally, be patient. Depending on the product, it will likely take to up a month before you can expect results.
 Always check with your health care provider before use of vitamins or supplements as some can interact with commonly used medications.
  

 Bryan M. Steele, DC
 O'Leary Chiropractic, PLLC

Common Conditions: Torticollis

 A common condition seen in practice is Torticollis. What is Torticollis you ask? Well, it's a 10 dollar word for a 2 dollar condition. That's not to downplay the debilitating effects of this condition on the sufferers. Torticollis is simply spasm of the cervical spine musculature to an extent where the head is often held in a rotated and/or lateral flexed position. Imagine the position of your head while you look out your driver's side mirror. This is often the position that people are "stuck" in.
 Cause of Torticollis should be investigated to rule out a more serious neurological condition. Many, I dare say most, conditions are benign in nature and usually caused by muscular or joint injury to the cervical spine. Treatments are initially focused on reducing pain and restoring normal mechanics of the neck. Torticollis sufferers doing very well with Chiropractic care and are relieved to realize that this condition is rarely a chronic, long lasting injury.
  

 Bryan M. Steele, DC

  Chiropractors focus on injuries of the neck, back and the pains associated with these injuries. Every Chiropractor will offer slight variations on which treatments they choose for you. I will discuss several of the most common approaches here today.
 On your first visit the Chiropractor will discuss the specifics of your injury, your health history, surgical history and medication use. This will allow the Chiropractor to determine if your condition is treatable and also rule out contraindications.
 Once it is determined that you are a good candidate for Chiropractic care a variety of modalities are often used which vary from ultrasound, electrical muscle stimulation, ice and or heating pack use. These modalities often are used to decrease inflammation or reduce muscle spasm at the site of injury. Myofascial trigger point therapy is often used to assist in relief of muscular pain and tightness associated with your injury. The most common therapy used is spinal manipulation, often called an adjustment. This focuses on loosening tightened joints and restoring normal motion of the joints in the back or neck. Exercise and stretching routines should be given to all patients to help them fully restore normal motion and strength once pain levels become more tolerable.

 Bryan M. Steele, DC

 In this day and age we have a variety of different tests/scans available to help make an accurate diagnosis. Often patients do not understand why they are having the test and what exactly the ordering healthcare professional is looking for. Below is a list of commonly used tests concerned with diagnosis of spinal pain, muscle pain, or nerve pain.
1. X-ray (radiograph) - Commonly used when fracture, dislocation or other bony pathology is in question. Soft tissues such as muscles, nerves, or discs of the spine are very poorly visualized, if at all.
2. MRI (magnetic resonance imaging) - Commonly used to diagnosis disc herniations, muscle/tendon tears, ligament damage, tumor as well as a host of other pathology. It should be noted that MRI uses very large and powerful magnets, hence the name, to obtain the images. There is no radiation dose with MRI unlike X-ray or CT scan.
3. CT scan (computerized tomography) - Commonly used to quickly diagnosis internal injuries to the abdomen, chest or brain. Often used with injected contrast material. A CT scan involves taking a series of x-rays through the affected area, much like slices of bread in a loaf. CT scans are general considered less discerning between different tissue types. For this reason they are used less often for musculo-skeletal diagnosis outside of a hospital setting.
4. EMG (electromyography) - EMG is primarily used to diagnosis nerve or muscular pathology. An EMG measures the nerve pathways in the body and is able to assess the health of your muscles and nerves that control them. EMG is commonly used to assess which structures are damaged in carpal tunnel type syndromes or with pinched nerves in the neck or back.
5. Bone Scan - A bone scan is commonly used to diagnosis bone diseases that may not be visible on x-ray. Bone scan is frequently used in to track potential spread of cancer. A bone scan may also be used for more benign conditions such as osteoporosis or suspected bone infection.

 As always more in-depth information can be found using your favorite search engine. Education is your best tool, read up!

The best exercises for core strength

 As promised last week, I will discuss exactly which exercises are best to strengthen and help prevent occurrences of lower back pain. It should first be noted that all exercise whether it be walking or far more aggressive power lifting put stress on the joints and muscles of the lower back. Injury occurs when more stress is put on those structures than they can withstand. The key to strong back and core is putting the right kinds of stress in the right amounts to stimulate muscular growth while minimizing chance of injury.
 Back to our Canadian friend Stuart McGill, PhD. Dr. McGill studied several exercises for the lower back. He measured two things; the amount of muscle activation and the amount of sheer stress and compressive force these exercises imparted on the lower back. The best exercises were chosen based on higher levels of muscle activation while putting lower amounts of sheer and compressive force on the spine. The result was an exercise program that would strengthen the correct muscles while decreasing the chance of injury during the exercise.
 The three exercises are as follows. The abdominal crunch, isometric Side Bridge and Bird Dog exercises. Visual instruction of these exercises can be found through your favorite search engine. Seems pretty simple, right? Certainly there are exercises that are more advanced and require more muscle activation but because of the complex nature and controlled movement required they often become injurious to the amateur rather than therapeutic. As with any exercise program, there are contraindications involved. It is recommended that you consult your health care professional before starting these or any exercise.

 Bryan M. Steele, DC